MHRA proposal to amend the POM Order and extend the range of medicines that may be prescribed by nurse prescribers.

The NPA welcomes the move to allow nurse prescribers to prescribe ‘black triangle’ drugs. These are fully licensed medicines and as nurses participate in the ‘yellow card’ adverse drug reaction reporting scheme, there restriction no longer seems necessary.

Proposed additions to the conditions currently treatable under the NPEF

We welcome the proposed additions to the range of conditions that can be treated by Extended Formulary Nurse Prescribers. We believe that this will lead to better patient care as patients will have improved access to the medicines they need. We see these additions being particularly useful in emergency care situations such as Accident and Emergency Units and Walk-In Centres.

Proposed extension in restricted circumstances of ‘off label’ or ‘off licence’ prescribing

The NPA supports this proposal, particularly in the field of palliative care. In our response to MLX 293 on a previous proposal to extend the range of medicines prescribable by extended formulary nurse prescribers, we made the point that nurses who are trained to provide palliative care are highly skilled healthcare professionals and should have access to medicines required to treat their patients. The NPA agrees that in certain circumstances, "off-label" prescribing in palliative care would be safe and effective practice. As an example, we are aware that midazolam is widely used as a sedative in terminal agitation although it is not licensed for this indication; it is also commonly used subcutaneously in syringe drivers and this route of administration is also unlicensed. However, we believe that it is imperative that Extended Formulary Nurse Prescribers (EFNPs) and Trusts as their employers, are made fully aware of the legal liability and professional indemnity issues involved in prescribing items "off-label".

Proposed extension of the prescribing of controlled drugs

We agree that EFNPs should be able to prescribe from a restricted range of controlled drugs (morphine, diazepam, lorazepam, midazolam). EFNPs may already prescribe diazepam, lorazepam and midazolam in palliative care and we welcome the extension of these prescribing rights to other conditions.

We note that the proposal includes the prescribing of morphine for acute severe pain after trauma but does not include the prescribing of these medicines in palliative care and suggest that this is included in a future extension to the NPEF.

Proposed amendments to the POM Order

The NPA has no specific comments to make on the individual medicines to be added to the NPEF.